ATI COMPREHENSIVE EXIT EXAM(
x x x x
NGN ATI) x
1. Treatxfirstxanyximmediatexthreatsxtoxaxpatient'sxsurvivalxorxsafety.
Ex.xobstructedxairway,xlossxofxconsciousness,xpsychologicalxepisodexorxanxietyxattack.x
ABC's.
2. Next,xtreatxactualxproblems.xEx.xnausea,xfullxbowelxorxbladder,xcomfortxmeasures.
3. Then,xtreatxrelativelyxurgentxactualxorxpotentialxproblemsxthatxthexpatientxorxfamilyxdoesxnotxreco
gnize.xEx.xMonitoringxforxpost-
opxcomplications,xanticipatingxteachingxneedsxofxaxpatientxthatxmayxbexunawarexofxsidexeffectsxofxm
eds.
4. Lastly,xtreatxactualxorxpotentialxproblemsxwherexhelpxmayxbexneededxinxthexfuture.
ExxTeachingxforxself-carexinxthexhome.
Herexarexsomexgreatxprinciplesxtoxhelpxyouxasxyouxprioritize:
,Systemicxbeforexlocalx
Acutexbeforexchronicx
Actualxbeforexpotentialx
Listenxdon'txassume
Recognizexfirstxthenxapplyxclinicalxknowledgex
Maslow'sxHierarchyxofxNeeds:
PrioritizexaccordingxtoxMaslowxwithxphysiologicalxandxsafetyxissuesxbeforexpsychologicalxesteemxi
ssues.
Variantxanginax(Prinzmetal'sxangina)
Duextoxaxcoronaryxarteryxspasm,xofteningxoccurringxduringxperiodsxofxrest.
Unstablexangina
Occursxwithxexercisexorxemotionalxstress,xbutxitxincreasesxinxoccurrence,xseverity,xandxdurationxo
verxtime.
Stablexangina
Occursxwithxexercisexorxemotionalxstressxandxisxrelievedxbyxrestxorxnitroglycerinx(Nitrostat).
electrolyteximbalancexmanifestations:x
hypocakelmia-->xflatxTxwavesxonxECG
hypercalcemia--
>xdecreasedxdeepxtendonxreflexesx(DTRs)xhypocalcemia--
>xtetany
hyperkalemia-->xtallxpeakedxTxwavesxonxECG
Addison'sxdisease
Decreasedxaldosteronexandxrenin
Hypothyroidism
Decreasedxtriiodothyroninex(T3)xandxthyroxine
,Cushing'sxdiseasex
Elevatedxcortisol
DiabetesxInsipidusx(DI)xDecreas
edxurinexspecificxgravity
Diabetesxmelitus
Elevatedxglycosylatedxhemoglobinx(HbA1c)
SyndromexofxInappropriatexSecretionxofxAntidiureticxHormonexI
ncreasedxurinexosmolality
Cataract
Progressivexandxpainlessxlossxofxvision
Angle-
closurexglaucomaxRapidxons
etxofxelevatedxIOP
macularxdegenerationx
Centralxlossxofxvision
Open-
anglexgalucomaxLossxofx
peripheralxvision
Retinalxdetachment
Suddenxlossxofxvisionxwithoutxpain
Commonxdisease'sxmanifestationsx
Cholecystitis-->xMurphy'sxsign
Pancreatitis-->xTurner'sxsign
PepticxUlcerxDisease-->xUpperxepigastricxpainx1-
2xhoursxafterxmealsxAppendicits-->xPainxatxMcBurney'sxpoint
Decorticate
, Decerebrate
Hepatitisxdiseasextransmissions
HepatitisxA--
>xIngestionsxoxcontaminatedxfood/waterxHepatitisxB--
>xUnprotectedxsexualxcontact
NonviralxHepatits-->xDrugxtoxicity
HeartxFailure
Symptoms:xShortnessxofxbreath,xfatigue,xjugularxveinxdistention,xandxanxS3xarexsigns/symptomsxofxh
eartxfailurexresultingxfromxthexdecreasedxpumpingxabilityxofxthexheartxandxincreasedxfluidxvolume.
Hypovolemicxshock
position:xSupinexwithxlegsxelevatedx(shockxposition)
Below-the-kneexamputation
Position:xThexclientxshouldxbexplacedxinxthexpronexpositionxseveralxtimesxaxdayxtoxpreventxhipxfl
exionxcontractions.
Chestxtube
-
Continuousxbublingxinxthexwaterxsealxchampersxindicatesxanxairxleak.xIfxthisxisxobserved,xthexnurs
exshouldxattemptxtoxlocatedxthexsourcexofxthexairxleakxandxintervenexaccordinglyx(tightenxthexconne
ctions,xreplacexdrainagexsystem)
Compartmentxsyndrome
Symptoms:xPulselessnessx(latexsign),xIncreasedxpainxunrelievedxwithxelevationxorxbyxpainx
medication
Leftxhomonymousxhemianopsia
hasxlostxthexleftxvisualxfieldxofxbothxeyes.xTheyxarexunablextoxvisualizexanythingxtoxthexleftxofxm
idlinexofxthexbody.
dialysisxfistula
clientxteaching:xavoidxliftingxheavyxobjectsxwithxaccess-
sitexarm,xavoidxcarryingxobjectsxthatxcompressxthexextremity,xavoidxsleepingxonxtopxofxthexextrem
ityxwithxthexaccessxdevice,xperform
x x x x
NGN ATI) x
1. Treatxfirstxanyximmediatexthreatsxtoxaxpatient'sxsurvivalxorxsafety.
Ex.xobstructedxairway,xlossxofxconsciousness,xpsychologicalxepisodexorxanxietyxattack.x
ABC's.
2. Next,xtreatxactualxproblems.xEx.xnausea,xfullxbowelxorxbladder,xcomfortxmeasures.
3. Then,xtreatxrelativelyxurgentxactualxorxpotentialxproblemsxthatxthexpatientxorxfamilyxdoesxnotxreco
gnize.xEx.xMonitoringxforxpost-
opxcomplications,xanticipatingxteachingxneedsxofxaxpatientxthatxmayxbexunawarexofxsidexeffectsxofxm
eds.
4. Lastly,xtreatxactualxorxpotentialxproblemsxwherexhelpxmayxbexneededxinxthexfuture.
ExxTeachingxforxself-carexinxthexhome.
Herexarexsomexgreatxprinciplesxtoxhelpxyouxasxyouxprioritize:
,Systemicxbeforexlocalx
Acutexbeforexchronicx
Actualxbeforexpotentialx
Listenxdon'txassume
Recognizexfirstxthenxapplyxclinicalxknowledgex
Maslow'sxHierarchyxofxNeeds:
PrioritizexaccordingxtoxMaslowxwithxphysiologicalxandxsafetyxissuesxbeforexpsychologicalxesteemxi
ssues.
Variantxanginax(Prinzmetal'sxangina)
Duextoxaxcoronaryxarteryxspasm,xofteningxoccurringxduringxperiodsxofxrest.
Unstablexangina
Occursxwithxexercisexorxemotionalxstress,xbutxitxincreasesxinxoccurrence,xseverity,xandxdurationxo
verxtime.
Stablexangina
Occursxwithxexercisexorxemotionalxstressxandxisxrelievedxbyxrestxorxnitroglycerinx(Nitrostat).
electrolyteximbalancexmanifestations:x
hypocakelmia-->xflatxTxwavesxonxECG
hypercalcemia--
>xdecreasedxdeepxtendonxreflexesx(DTRs)xhypocalcemia--
>xtetany
hyperkalemia-->xtallxpeakedxTxwavesxonxECG
Addison'sxdisease
Decreasedxaldosteronexandxrenin
Hypothyroidism
Decreasedxtriiodothyroninex(T3)xandxthyroxine
,Cushing'sxdiseasex
Elevatedxcortisol
DiabetesxInsipidusx(DI)xDecreas
edxurinexspecificxgravity
Diabetesxmelitus
Elevatedxglycosylatedxhemoglobinx(HbA1c)
SyndromexofxInappropriatexSecretionxofxAntidiureticxHormonexI
ncreasedxurinexosmolality
Cataract
Progressivexandxpainlessxlossxofxvision
Angle-
closurexglaucomaxRapidxons
etxofxelevatedxIOP
macularxdegenerationx
Centralxlossxofxvision
Open-
anglexgalucomaxLossxofx
peripheralxvision
Retinalxdetachment
Suddenxlossxofxvisionxwithoutxpain
Commonxdisease'sxmanifestationsx
Cholecystitis-->xMurphy'sxsign
Pancreatitis-->xTurner'sxsign
PepticxUlcerxDisease-->xUpperxepigastricxpainx1-
2xhoursxafterxmealsxAppendicits-->xPainxatxMcBurney'sxpoint
Decorticate
, Decerebrate
Hepatitisxdiseasextransmissions
HepatitisxA--
>xIngestionsxoxcontaminatedxfood/waterxHepatitisxB--
>xUnprotectedxsexualxcontact
NonviralxHepatits-->xDrugxtoxicity
HeartxFailure
Symptoms:xShortnessxofxbreath,xfatigue,xjugularxveinxdistention,xandxanxS3xarexsigns/symptomsxofxh
eartxfailurexresultingxfromxthexdecreasedxpumpingxabilityxofxthexheartxandxincreasedxfluidxvolume.
Hypovolemicxshock
position:xSupinexwithxlegsxelevatedx(shockxposition)
Below-the-kneexamputation
Position:xThexclientxshouldxbexplacedxinxthexpronexpositionxseveralxtimesxaxdayxtoxpreventxhipxfl
exionxcontractions.
Chestxtube
-
Continuousxbublingxinxthexwaterxsealxchampersxindicatesxanxairxleak.xIfxthisxisxobserved,xthexnurs
exshouldxattemptxtoxlocatedxthexsourcexofxthexairxleakxandxintervenexaccordinglyx(tightenxthexconne
ctions,xreplacexdrainagexsystem)
Compartmentxsyndrome
Symptoms:xPulselessnessx(latexsign),xIncreasedxpainxunrelievedxwithxelevationxorxbyxpainx
medication
Leftxhomonymousxhemianopsia
hasxlostxthexleftxvisualxfieldxofxbothxeyes.xTheyxarexunablextoxvisualizexanythingxtoxthexleftxofxm
idlinexofxthexbody.
dialysisxfistula
clientxteaching:xavoidxliftingxheavyxobjectsxwithxaccess-
sitexarm,xavoidxcarryingxobjectsxthatxcompressxthexextremity,xavoidxsleepingxonxtopxofxthexextrem
ityxwithxthexaccessxdevice,xperform
